Symptoms and Complications
The symptoms associated with HSV-1 and HSV-2 infections are quite similar.
Genital Herpes (Type 2) Symptoms The incubation period of genital herpes is 2 to 14 days, and the symptoms usually last 2 to 4 weeks (Centers for Disease Control, 2009f;
Sexually Transmitted Infections
Looker et al., 2008). However, many individuals with genital herpes experience minimal or no recognizable symptoms (Centers for Disease Control, 2009f). When symptoms are present, they consist of one or more small painful red bumps, called papules, that usually appear in the genital region. In women the areas most commonly infected are the labia. The mons veneris, clitoris, vaginal opening, inner vaginal walls, and cervix can also be affected. In men the infected site is typically the glans or shaft of the penis. Men and women who have engaged in anal intercourse can develop eruptions in and around the anus.
Soon after their initial appearance, papules rapidly develop into tiny painful blisters filled with a clear fluid containing highly infectious virus particles. The body then attacks the virus with white blood cells, causing the blisters to fill with pus (see I Figure 15.4). Soon the blisters rupture to form wet, painful open sores surrounded by a red ring (health practitioners refer to this as the period of viral shedding). A person is highly contagious during this time. About 10 days after the first appearance of a papule, the open sore forms a crust and begins to heal—a process that can take as long as 10 more days. Sores on the cervix can continue to produce infectious material for as long as 10 days after labial sores have completely healed. Consequently, it is wise to avoid coitus for a 10-day period after all external sores have healed.
Other symptoms can accompany genital herpes, including swollen lymph nodes in the groin, fever, muscle aches, and headaches. In addition, urination may be accompa – Critical Thinking Question nied by a burning sensation, and women may experience increased vaginal discharge.
Oral Herpes (Type 1) Symptoms Oral herpes is characterized by the formation of papules on the lips and sometimes on the inside of the mouth, on the tongue, and on the throat. These blisters tend to crust over and heal in 10 to 16 days. Other symptoms include fever, general muscle aches, swollen lymph nodes in the neck, flulike symptoms, increased salivation, and sometimes bleeding in the mouth.
Recurrence Even after complete healing, lesions can recur. Unfortunately, the herpes virus does not typically go away; instead, it retreats up the nerve fibers leading from the infected site (Colgan et al., 2003). Ultimately, the genital herpes virus finds a resting place in nerve cells adjacent to the lower spinal column, whereas the oral herpes virus becomes lodged in nerve cells in the back of the neck. The virus can remain dormant in these cells, without causing any apparent damage, perhaps for a person’s entire lifetime. However, in many cases there will be periodic flare-ups as the virus retraces its path back down the nerve fibers leading to the genitals or lips.
Although some people never experience a recurrence of herpes following the initial or primary infection, research suggests that most people who have undergone a primary episode of genital herpes infection experience at least one recurrence. Individuals who experience recurrences may do so frequently or only occasionally. Symptoms associated with recurrent attacks tend to be milder than primary episodes, and the infection tends to run its course more quickly.
Most people prone to recurrent herpes outbreaks experience some type of prodro – prodromal symptoms mal symptoms that warn of an impending eruption. These indications include itch – Symptoms that warn of an impending ing, burning, throbbing, or "pins-and-needles" tingling at the sites commonly infected by herpes erupti°n – herpes blisters, and sometimes pain in the legs, thighs, groin, or buttocks. Many health authorities believe that a person’s degree of infectiousness increases during this stage and that it further escalates when the lesions appear. Consequently, a person should be particularly careful to avoid direct contact from the time he or she first experiences prodromal symptoms until the sores have completely healed. Even during an outbreak, it is possible to continue sexual intimacies with a partner, as long as infected skin does not come into contact with healthy skin. During this time, partners may wish to experiment with other kinds of sensual pleasuring, such as sensate focus (see Chapter 14), hugging, or manual stimulation.
A variety of factors can trigger reactivation of the herpes virus, including emotional stress, anxiety, depression, acidic food, ultraviolet light, fever, menstruation, poor nutrition, being overtired or run-down, and trauma to the affected skin region. Because triggering factors vary so widely, it is often difficult to associate a specific event with a recurrent herpes outbreak.
Some people may not experience a relapse of genital herpes until several years after the initial infection. Therefore, if you have been in what you believe is a sexually exclusive relationship and your partner shows symptoms or transmits the virus to you, it does not necessarily mean that she or he contracted the infection from someone else during the course of your relationship. Furthermore, as stated earlier, many people with genital herpes infections are asymptomatic or have mild symptoms that are often unrecognizable. Thus a first episode of symptomatic genital herpes may not be due to recent sexual contact with an infected person (Centers for Disease Control, 2009f).
Other Complications Although the sores are painful and bothersome, it is unlikely that men will experience major physical complications of herpes. Women, however, face two serious, although quite uncommon, complications: cancer of the cervix and infection of a newborn. Evidence suggests that the risk of developing cervical cancer is somewhat higher among women who have had genital herpes (Centers for Disease Control,
2006b). However, the role of genital herpes in cervical cancer is at most that of a cofactor, not that of a direct causative agent (Centers for Disease Control, 2006b). Fortunately, the great majority of women infected with herpes will never develop cancer of the cervix. Nonetheless, it is advisable for all women, particularly those who have had genital herpes, to obtain an annual cervical Pap smear. Some authorities recommend that women with genital herpes should have this test every 6 months.
A newborn can be infected with genital herpes while passing through the birth canal, and such an infection can cause severe damage or death (Looker et al., 2008; Workowski et al., 2010). It is believed that viral shedding from the cervix, vagina, or vulva plays the primary role in transmitting the infection perinatally from mother to infant. The risk of a pregnant mother transmitting genital herpes to her newborn is highest for women who are first infected during late pregnancy (Workowski et al., 2010). The CDC recommends that these women should consult with an infectious disease specialist to determine how to manage the impending birth.
Sexually Transmitted Infections
The presence of a genital herpes infection is associated with a two – to threefold increased risk of acquiring an HIV infection when exposed to HIV through sexual activity (Looker et al., 2008). The risk of transmission of HIV by a person infected with both HIV and HSV is estimated to increase fivefold on a per-sexual-act basis (Looker et al., 2008).
One additional serious complication can occur when a person transfers the virus to an eye after touching a virus-shedding sore. This can lead to a severe eye infection known as ocular herpes (Karpecki & Shechtman, 2011). The best way to prevent this complication is to avoid touching herpes sores. If you cannot avoid contact, thoroughly wash your hands with hot water and soap immediately after touching the lesions. There are effective treatments for ocular herpes, but they must be started quickly to avoid eye damage.
Many people who have recurrent herpes outbreaks are troubled with mild to severe psychological distress (Barnack-Tavlaris, 2011; Merin & Pachankis, 2011). In view of the physical discomfort associated with the infection, the unpredictability of recurrent outbreaks, and the lack of an effective cure (see next section), it is no small wonder that people who have herpes undergo considerable stress. We believe that becoming better informed about herpes may help to alleviate some of these emotional difficulties. In addition, talking with supportive partners might ease a person’s psychological adjustment to recurrent genital herpes infections. Certainly, herpes is not the dread infection that some people believe it to be. In fact, many individuals have learned to cope effectively with it, as did the person in the following account:
When I first discovered I had herpes several years ago, my first reaction was, "Oh no, my sex life is destroyed!" I was really depressed and angry with the person who gave me the infection. However, with time I learned I could live with it, and I even began to gain some control over it. Now, on those infrequent occasions when I have an outbreak, I know what to do to hurry up the healing process. (Authors’ files)